From the Guidelines
The use of pentoxifylline and vitamin E may be considered as an adjunctive approach to prevent medication-related osteonecrosis of the jaw (MRONJ), but the evidence is not strong enough to recommend it as a standard preventive measure. A typical regimen that has been studied includes pentoxifylline 400 mg twice daily combined with vitamin E (alpha-tocopherol) 1000 IU daily, sometimes used for several months before and after dental procedures in high-risk patients, as seen in the study by Samani et al 1. These medications may help by improving blood flow to bone tissue (pentoxifylline is a vasodilator and hemorheologic agent) and reducing oxidative stress (vitamin E is an antioxidant), potentially counteracting some mechanisms that lead to MRONJ.
Some key points to consider when evaluating the use of pentoxifylline and vitamin E for MRONJ prevention include:
- The study by Lyons et al, which managed 28 patients with pentoxifylline and vitamin E alone, resulting in resolution of osteoradionecrosis (ORN) in 17 patients, and improvement or stabilization in the remaining 11 patients 1.
- The retrospective cohort study by Samani et al, which found that patients with full compliance to the pentoxifylline and tocopherol regimen had significantly lower ORN rates compared to the control group 1.
- The importance of comprehensive dental evaluation before starting antiresorptive therapy, maintaining excellent oral hygiene, regular dental check-ups, and avoiding invasive dental procedures when possible in high-risk patients, as recommended by the MASCC/ISOO/ASCO clinical practice guideline 1.
However, prevention of MRONJ should primarily focus on established strategies including comprehensive dental evaluation before starting antiresorptive therapy, maintaining excellent oral hygiene, regular dental check-ups, and avoiding invasive dental procedures when possible in high-risk patients. The pentoxifylline and vitamin E combination should be considered an adjunctive approach rather than a replacement for these fundamental preventive measures, and patients should discuss this option with both their dentist and physician to determine if it's appropriate for their specific situation.
From the Research
Medication-Related Osteonecrosis of the Jaw (MRONJ) Prevention and Treatment
- The use of pentoxyfylline (Pentoxifylline) and vitamin E has been studied as a potential treatment for MRONJ, with some studies showing promising results 2, 3, 4.
- A 2016 study found that pentoxifylline and tocopherol (PENT-E) may be an effective adjunct in the management of MRONJ, with all patients demonstrating relief of symptoms and radiographic evidence of new bone fill 2.
- A 2025 study found that pentoxifylline and tocopherol therapy was effective in patients with MRONJ, with complete remission occurring in 46% of subjects 3.
- The exact mechanism of how pentoxyfylline and vitamin E help prevent MRONJ is not fully understood, but it is thought to be related to their anti-fibrotic and anti-inflammatory properties 4.
Risk Factors and Prevention
- MRONJ is a major problem that can occur in people taking certain medications such as bisphosphonates and denosumab, and can be used to treat osteoporosis or cancer 5.
- Careful dental preparation and oral hygiene instructions can significantly minimize the risk of osteonecrosis of the jaw (ONJ) 5, 6.
- Dentists have a critical role in preventing MRONJ through prophylactic dental care and maintenance of good oral hygiene 6.